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Friday
Mar152019

An Innovative Acquisition for HCA

by Clive Riddle, March 15, 2019

Nashville-based HCA Healthcare has just announced that HCA will become the majority owner of the parent company of Galen College of Nursing, one of the largest educators of nurses in the nation.  HCA, of course, is one of the nation’s leading providers of healthcare services, comprising 185 hospitals and approximately 1,800 sites of care.

The announcement states that “The innovative new strategic partnership brings together two of the top nursing organizations in the country in order to increase access to nursing education and provide career development opportunities in nursing to improve patient care. With 94,000 registered nurses, HCA Healthcare is one of the largest employers of nurses in the country, with nurses holding positions from bedside caregivers in a variety of healthcare settings to leadership positions throughout the organization.”

Hospital funding and partnerships for nursing education certainly isn’t new. For example, here’s a website providing a state-by-state listing of 123 such hospital arrangements, which they acknowledge is only a partial list.

But what is innovative is to move beyond strategic partnerships with an outright acquisition.  Not only does the move create synergy for HCA’s staff career development, it should also serve as a burse recruitment tool for HCA, in an environment where hospitals compete for nursing staffing.

Furthermore, this perhaps signals that healthcare organizations will continue to peek and climb further out-of-the-box with acquisitions beyond traditional M&A of other healthcare providers.  Deloitte, in a discussion of the Health Plan of Tomorrow that is the subject of an upcoming webinar, writes that "buy, share or build? is a question many health plan leaders will face as they begin this transformation journey. And accessing these capabilities may require an industry-agnostic approach. As new players break the rules around who plays what role in the industry, health plans may need to turn to want might today be considered strange bedfellows: competitors, providers, manufacturers, technology companies, transactional sector companies, and/or other industries for answers."

The same holds true for healthcare providers as for health plans.  And so HCA and Galen seem to be pairing up on a transformative journey as well.

Friday
Mar082019

We’re #1! Healthcare Leads the Way in Travel and Wait Times

by Clive Riddle, March 8, 2019

Altarum recently released a six page report: Travel and Wait Times are Longest for Health Care Services and Result in an Annual Opportunity Cost of $89 Billion” which compiled data for the Bureau of Labor Statistics’ American Time Use Survey. Their study found “waiting times for health care services in particular were much higher than the other service categories, over twice the length of the next closest, veterinary services.”

Alturm reports that “the time spent traveling and waiting for health care services on a day when an individual got care was over 50% of the time spent actually receiving care—45 combined minutes traveling & waiting vs. 76 minutes receiving care (data not shown). Among all time spent on health care related activities (self-care, assisting others, receiving professional care, waiting and travel), travel and waiting for care accounted for 19.7% of the total time spent, on average over two minutes a day or an hour per month.”

Altarum outs a price tag and all this traveling and waiting: “When quantified by applying an individual’s hourly wage as an approximate measure of the economic cost of time spent, travel and waiting costs averaged $89 billion dollars annually from 2006 thru 2017.”  But the really sad news is that “despite significant investments in the United States over this period in improving access to health care through better insurance, the use of innovative delivery systems, and advances in digitizing health care records and automating administrative processes, travel and wait times show no discernable improvements in these data from 2006 to 2017.” 

Vitals, recently acquired by WebMD, has annually released a report on physician wait times, Their most recent report tells us that where you’re traveling to or from makes a big difference in physician waits. Wisconsin has the shortest average wait time of 13 minutes 23 seconds while Alabama comes in as the longest with 22 minutes 19 seconds.  Your wait in Seattle averages 14 minutes 38 seconds (second shortest city– three seconds longer than Milwaukee) while a wait in El Paso comes in as the longest at 26 minutes 50 seconds. 

Vitals also reports that “30 percent of people reported they’ve walked out of an appointment due to long waits. What’s more, 1 in 5 report they’ve changed doctors because of long wait times.”

 

Friday
Mar082019

Four Questions for Aaron Fulner, Senior Director, Product Marketing, Edifecs, Post-Webinar Interview: 

By Claire Thayer, March 8, 2019

Recently, Aaron Fulner, Senior Director, Product Marketing with Edifecs, participated in a Healthcare Web Summit webinar discussion that illustrates how health plans participating in government-sponsored programs, such as Medicare Advantage, can take off the blindfold and improve risk-adjusted revenue accuracy as well as value-based program performance. If you missed this informative webinar presentation, “No More Blindfolds: Improving Value-Based Outcomes and Optimizing Revenue,” we invite you to watch the On-Demand version here.

After the webinar, we interviewed Aaron on four key takeaways from the discussion:

1.  Can you explain the impact on provider satisfaction as a result of this approach?

Aaron Fulner: By enabling a health plan to be more targeted with their requests, and reducing the overall volume of requests, provider abrasion can be reduced.

2. There's a lot of discussion in the industry around A.I. and machine learning.  What are some of the trends in AI that Edifecs is particularly excited about?

Aaron Fulner: In discussions with our partners, we are seeing a lot of industry excitement around the ability to stem the tide of opioid abuse and also the application of AI and ML technologies to more accurately identify targets to prevent disease progression and readmissions, improve patient medication adherence, project value-based care outcomes, improve risk-adjusted revenue integrity and Stars/HEDIS scores.

3. What are some of the challenges of having claims and clinical data in separate siloes?

Aaron Fulner: When plans house claims and clinical data in separate siloes it renders any correlation between the two datasets, at worst, impossible and, at best, unusable or irrelevant given the lag time and the spreadsheet-based process employed by most plans. When this occurs, plans miss out on additional dimensions of data that can be used to improve intervention planning and value-based program performance, not to mention enhanced risk-adjusted revenue integrity.

4. In your Food for Thought discussion, you mentioned importance for good insight into submitted encounter data and how this relates to the risk scores and subsequent reimbursement received back from CMS. Can you elaborate more here?

Aaron Fulner: Without complete visibility into the encounter lifecycle, managed care plans can lose sight of the volume and quality of claims submitted vs encounters submitted. Additionally, especially for managed Medicaid plans operating in states with stringent timeliness and completeness requirement, there can be significant penalties for not meeting those standards. Also, and this paramount, plans can lose sight of exceptions/rejections coming back from CMS for Medicare Advantage. Poor visibility and a lack of prioritized workflows can negatively impact optimal risk scoring and therefore reduce risk-adjusted revenue integrity.

Friday
Mar012019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

Medicare Trims Payments To 800 Hospitals, Citing Patient Safety Incidents

Eight hundred hospitals will be paid less by Medicare this year because of high rates of infections and patient injuries, federal records show.

Kaiser Health News

Friday, March 1, 2019 

CMS considers tossing hospital star ratings methodology

The CMS is considering scrapping the model it uses to assign hospital star ratings, signaling a big shift from the agency's stance just seven months ago.

Modern Healthcare

Thursday, February 28, 2019 

Did some pharma execs offer misleading testimony to a Senate committee?

During Tuesday’s Senate hearing on drug pricing, each of the seven pharma execs insisted their companies have never withheld samples from generic rivals, a step that has raised concerns about unfairly thwarting competition.

Stat News

Thursday, February 28, 2019 

Anthem Says Bid to Save $49 Billion Deal Was ‘Cut Off at Knees’

Cigna Corp. officials did everything they could to sabotage a $48.9 billion merger with Anthem Inc., including refusing to consider divestitures that would have helped the deal win regulatory approval, Anthem’s general counsel told a judge.

Bloomberg

Tuesday, February 26, 2019 

U.S. Judge Will Not Block Amazon-Berkshire-JPMorgan Health Venture's New Hire

The decision by U.S. District Judge Mark Wolf in Boston came in a lawsuit closely watched in the industry for clues about the future plans of the venture, which was announced in January 2018 with a goal of lowering healthcare costs.

NY Times

Monday, February 25, 2019

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 

Monday
Feb252019

Stakeholders Pick Rx Costs & Pricing as Topic With Greatest Impact This Year

Clive Riddle. February 25, 2019 

MCOL and Healthcare Web Summit jointly sponsored a survey of healthcare professionals on which of three key topics would have the greatest impact, and what stakeholders would be economic winners and losers during this year. Here’s a summary of the findings: 

Participants were asked to respond to three items:

 1.  Which one of these three topics will have the greatest impact on stakeholders in 2019? 

  • Medicaid Funding and Eligibility
  • Pharmaceutical Costs and Pricing
  • Value Based Care Initiatives  

2. Please project who you think the economic winners and losers for 2019 will be. Who do you think will be economically better off, the same or worse off by this time next year: Consumers; Employers; Health Plans; Hospitals; Physicians; Pharmaceutical 

3. Please indicate your perspective 

  • Purchaser (Health Plan, Employer, TPA, Agent, PBM)
  • Provider (Hospital, Physician, Pharmaceutical, Other Providers)
  • Vendor or Other  

Stakeholders overall (51.7%) selected Pharmaceutical Costs and Pricing as the topic having the greatest impact in 2019, compared to Value Based Care Initiatives (31.7%) and Medicaid Funding and Eligibility (16.7%). 

Providers (54.5% and Vendor/Other (52.0%) respondents both selected Rx as the top choice, but Purchasers selected Value Based Care (53.8%) slightly over Rx (46.2%).  More Providers selected Medicaid (27.3%) over Value Based care (27.3%), while Vendors chose Value Based Care (32.0%) over Medicaid (16.0%)

More respondents (45.2%) overall selected Pharmaceutical Stakeholders vs. other categories as being better off in 2019  Health Plans came in second for being better off at 33.9%. Hospitals reflected the least optimism, with just 18.0% viewing them as better off this year. 

Hospitals thus were viewed with the most pessimistic outlook, with 65.2% feeling they will be worse off this year. Physicians were next in line, at 56.5%.Health Plans and Pharmaceutical stakeholders tied for the least pessimism, each with 21.7% viewing them as worse off this year. 

It should be noted that these levels of pessimism have generally declined from last year. The top three choices for being worse off in last year’s epoll all dropped: Consumers from 68.&% in 2018 to 38.7% in 2019; Hospitals from 57.2% in 2018 to 49.2% in 2019; and Physicians from 50.8% in 2018 to 29.0% in 2019. 

Purchasers had a rosier view for Consumers and Pharmaceutical stakeholders, with 46.2% saying Consumers would be better off, compared to 23.7% of Providers and 23.1% of Vendors/Others; and 61.5% of Purchasers saying Pharmaceutical would be better off compared to 39.1% of providers and 42.3% of Vendors/Others. 

Providers saw themselves in a worse position for 2019 compared to other respondents. 65.2% of Providers said Hospitals would be worse off, compared to 38.5% of Purchasers and40.0% of Vendors/Others. 56.5% of Providers said Physicians would be worse off, compared to 30.8% of Purchasers and 34.0% of Vendors/Others.